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Queasiness and constipation are common complaints among pregnant women. For some, though, these symptoms compound the digestive discomfort they’ve been enduring for years.

IBD, which is different from irritable bowel syndrome (IBS), is a broad term that describes autoimmune diseases of the gastrointestinal tract. The two most common forms of IBD are ulcerative colitis and Crohn’s disease. Both cause inflammation of the intestines, which results in abdominal pain, diarrhea, and loss of appetite that come and go in periods of remissions and flares. Crohn’s usually affects the small bowel (although it can affect any part of the bowel), while ulcerative colitis affects the large bowel.

About 1 million Americans have inflammatory bowel disease (IBD). And because IBD most often affects women of childbearing age, digestive disorders and pregnancy commonly overlap. If kept in check, however, IBD may not disrupt the course of a healthy pregnancy.

Digestive Disorders and Conception

If you're a woman with IBD, surely you’ve wondered if your digestive disorder might affect your ability to get pregnant. The short answer is that it might if you don’t keep IBD under control.

“Both ulcerative colitis and Crohn’s disease can impact a woman’s fertility,” said Jennifer Bonheur, MD, a gastroenterologist at Gotham Gastroenterology in New York City.

Having IBD in and of itself does not change your ability to get pregnant, but having uncontrolled IBD does. “Women with IBD in remission with no active symptoms do not experience a decreased ability to conceive as compared to the general population,” Dr. Bonheur said.

On the flip side, the effects of uncontrolled IBD, such as uncomfortable gastrointestinal symptoms and malnutrition, can create problems with fertility.

“If a mom can’t stay nourished because of IBD symptoms like bleeding and diarrhea, it makes it difficult for the baby to get the necessary nutrition,” said Meagan Costedio, MD, a colorectal surgeon at the Cleveland Clinic. IBD can also inflame the fallopian tubes and ovaries, interfering with conception, she said.

In addition, pregnancy complications such as preterm labor and low birth weight are more common in women with ill-managed IBD.

For all these reasons, suppressing IBD symptoms is key to maintaining fertility in women who hope to get pregnant.

Getting the Upper Hand on Digestive Disorders

To keep digestive disorders in check, most people take medications — some of which are safe to take during pregnancy, while others aren’t. For instance, women with IBD — or male partners of women who have IBD and are hoping to conceive — should stop taking the drug methotrexate (Trexall) at least three to six months before trying to get pregnant.

Another factor that may influence your chance of pregnancy is a history of surgery for IBD. Open pelvic procedures, for instance, can cause scar tissue around the fallopian tubes and impact fertility, Dr. Costedio said. A good alternative to open surgery may be laparoscopy. “Recent studies show, if pelvic surgery is done laparoscopically, women have a better chance of getting pregnant,” she said.

Women who have an ostomy — a surgery that creates an opening from the inside of the body to the outside — as a treatment for IBD can rest assured it will not affect fertility, the uterus, or the baby, Costedio added.

Digestive Disorders and Pregnancy

During pregnancy, IBD flares won't worsen and may in fact subside. To ensure the best possible outcome, you should discuss your condition with both your gastroenterologist and your obstetrician, and pay special attention to certain aspects of your health:

Prioritize good nutrition. Because women with IBD are already at increased risk for vitamin and mineral deficiencies, folic acid, iron, and vitamin B12 supplements are particularly important, Bonheur said. “Ideally, women should start taking these supplements before they conceive.”

Prevent flares. This usually involves medications. “One of the most common mistakes I see is when IBD patients who get pregnant in remission stop taking their IBD medications,” said Mariam Fayek, MD, gastroenterologist at Women & Infants Center for Women’s Gastrointestinal Health in Providence, R.I. “This puts them at high risk for a disease flare.” In most cases, the benefits of controlling IBD and promoting the mother’s overall health far outweigh the risks of IBD medications. “With the exception of methotrexate, almost all IBD medications are considered safe in pregnancy and breastfeeding,” Dr. Fayek said. Talk to your doctor about the risks and benefits of your specific regimen before, during, and after your pregnancy.

Digestive Disorders and Delivery

Some women may want to request specific delivery approaches. “IBD can affect mode of childbirth," Bonheur said. "This is an important decision a woman should make together with her obstetrician, gastroenterologist, and colorectal surgeon."

For instance, women with Crohn’s disease — a condition that affects their rectum or perineum (in the form of fistulas or abscesses) — may want to consider a cesarean delivery. “This is because vaginal delivery can cause trauma and make the condition worse,” Bonheur said. Women who have undergone a procedure called restorative proctocolectomy may also want to avoid a vaginal delivery and opt for a c-section instead.

Overall, if you have IBD and want to get pregnant, the news is good. As long as symptoms are under control, most women with the condition can embrace motherhood and look forward to a happy, healthy pregnancy.

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